Abstract

The organizational climate is related to the degree of motivation of its employees. This perception is essentially felt, it is neither seen nor touched, but it is real. This study aims to identify difficulties and potentialities related to the organizational climate of the nursing staff at a public hospital in the Federal District. Methodologically, a descriptive and exploratory study was carried out characterized by a qualitative approach. The thematic content analysis led to three interpretative dimensions: environment and working conditions; communication, interpersonal relationship and work flows; motivation to improve the work environment. The results indicate a deficit of human resources, scarcity of material resources, supplies, precarious physical structure, in addition to interpersonal relationship problems, such as the (de)valuation of professional nurses and nursing. The challenges posed to managers go beyond the technical and structural dimension, the technological complexity of equipment without maintenance, as it unfolds through the human dimension, feelings and unmet needs (of appreciation) of nursing, which needs to be cared for, valued, heard and seen in their care process.

Key words:
Public Hospitals; Collaborative Workplace; Nursing Team; Interpersonal Relations

Introduction

The organizational climate corresponds to the workers’ perception of an organization regarding their work environment¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.. It is important to know this perception, as the feeling people have about the company has a profound impact on how and how much they work. According to Chiavenato²2 Chiavenato I. Administración de Recursos Humanos. 9ª. ed. México: McGraw-Hill; 2017., the organizational climate is the quality of the organizational environment perceived by the organization members and which influences the personal behavior of each professional. It can be favorable when it meets the workers’ personal needs, unfavorable when it results in frustration of the needs and neutral when this climate is indifferent to the participants, leading them to not care about what happens in the organization.

This perception of the climate is essentially felt by workers, it cannot be seen or touched, but it is real. For each worker, in particular, the climate takes the form of a set of attitudes and expectations that describe the organization, either in terms of static characteristics, such as the degree of autonomy, or in terms of behavioral variables. Therefore, the organizational climate maps the internal environment of the institution, translates tensions and desires, captures personal satisfactions and dissatisfactions, and paints a picture of the problems that the experienced situation causes³3 Keller E, Aguiar MAF. Análise crítica teórica da evolução do conceito de clima organizacional. Rev Terra Cultura Cad Ensino Pesq 2020; 20(39):91-113..

Despite the theoretical plurality on the subject, certain dimensions are common to most authors when it comes to the organizational climate of health institutions, with safety, interpersonal relationships, leadership, and motivation being the most discussed ones⁴4 Devi KM, Singh WC. Hospital staff perception of structural organizational climate dimension. Humanities Soc Sci Rev 2020; 8(2):744-755.

5 Ribeiro LAM, Veiga HMS. Bem-estar no trabalho: influência do clima organizacional entre trabalhadores hospitalares. Rev Psicol Saude 2022; 14(1):63-76.

6 Pantaleão PF, Veiga HMS. Bem-estar no trabalho: Revisão sistemática da literatura nacional na última década. HOLOS 2019; 5:1-24.^-77 Veiga HMS, Cortez PA. Preditores de bem-estar em trabalhadores identificados na literatura em Psicologia no Brasil. Rev Admin Mackenzie 2020; 21(4):1-29.. Health organizations present themselves as one of the important settings in which interpersonal relationships take place and the hospital environment, although endowed with specific nuances, preserves the same dynamics as other organizations⁸8 Mello RDCC, Reis LB, Ramos FP. Stress in nursing professionals: the importance of the organizational climate variable. Gerais: Rev Interinstit Psicol 2018; 11(2):193-207.. Good organizational performance requires managers to have a high capacity to merge the different elements that make up their organizational structure.

The internal environment and institutional arrangements existing in healthcare organizations versus the level of motivation of each professional are important elements for analyzing the organizational climate, which, in a certain way, influences motivation, performance, quality of services, as well as users’ and workers’ satisfaction¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,99 Bracarense CF, Costa NDS, Raponi MBG, Goulart BF, Chaves LDP, Simões ALDA. Clima organizacional e intenção de rotatividade de enfermeiros: estudo de método misto. Rev Bras Enferm 2022; 75(4):e20210792.. The hospital environment, the focus of this study, presents itself as a scenario in which interpersonal relationships are necessary to carry out tasks, and although it has specific nuances, it preserves the same dynamics as in other organizations¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642..

In view of the above, this study aims to identify the main difficulties related to the organizational climate among employees of a public hospital in the Federal District, Brazil, aiming to present suggestions that can improve team performance and patient care.

Method

This is a qualitative, exploratory-descriptive study. The qualitative approach seeks to understand practices and discourses as objectified human actions, resulting from social interactions, since the particularities of the environment disclose to the subjects peculiar traits that are revealed based on the meanings it establishes, considering the broad universe of beliefs, values , aspirations, meanings, motives and attitudes that are inserted in the world of human relationships and which are not perceptible in average and statistical variables¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1010 Minayo MCDS. O desafio do conhecimento: pesquisa qualitativa em saúde. 14ª ed. São Paulo, Rio de Janeiro: Hucitec, Abrasco; 2014..

The research was carried out with 46 nurses from a public hospital in the Federal District. Nurses from all care sectors were invited, including nursing supervisors, which characterizes the amplitude of the research. The inclusion criteria for participants comprised: being a nurse, working in the Hospital care units and accepting to participate in the study. The exclusion criteria comprised being a nurse, working in the care units of the assessed hospital and not accepting to participate in the study¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642..

A non-probabilistic convenience sample¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1111 Vergara SC. Projetos e relatórios de pesquisa em Administração. São Paulo: Atlas; 2009. of 46 nurses who work in both care and management was used in the study. Nurses who work in the adult Emergency Room, Children’s Emergency Room, Obstetric Center, Rooming-in Service, adult ICU, NICU (neonatal ICU), Internal Medicine Unit (ward), Surgical Clinic Unit (ward), Pediatrics (ward), Surgical Center and Material and Sterilization Center (MSC) participated in the study. The exhaustion of new topics in the respondents’ discourses was used as a sample saturation parameter¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1212 Flick U. Introdução à pesquisa qualitativa. 3ª ed. Porto Alegre: Artmed; 2009.. Interview data collection took place from October 10 to November 30, 2021. A semi-structured interview guide with open questions was used, in accordance with the objectives of the study¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642..

The interviews were carried out at the nurses’ workplace, in an environment chosen by them, after explaining the objective, the dynamics of the interview and after ensuring anonymity, authorization was requested to record the interviews, clarifying that this procedure would facilitate the study. As much as possible, we sought to make the environment as comfortable as possible, in an informal way, without imposing barriers to communication with the interviewees.

Each employee was interviewed once, and no time limit was set for the duration of the interview¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.. They were asked about their perception of the main difficulties that corroborate dissatisfaction in the work environment and how these difficulties could be corrected. The interviews were recorded on digital media for subsequent transcription and data analysis¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.. To ensure the anonymity of the statements, the respondents were identified with the letter (N=Nurse) followed by the ordinal numbering and sector of origin of the subjects (N1-NICU).

The data were analyzed using Bardin’s content analysis¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1313 Bardin L. Análise de conteúdo. São Paulo: Edições 70; 2011.. Based on the researchers’ experience in the researched scenario, an attempt was made to interpret the phenomenon from the respondents’ perception, recovering from the speeches the significant statements in relation to the organizational climate and identifying the corresponding cores of meaning. The speeches collected through the interviews were transcribed and each of them was read several times aiming to recover from these speeches the significant statements that emerged with the topic. Therefore, the respondents’ statements were reduced into units of meaning and categorized into three meaning cores: 1 - Environment and working conditions; 2 - Communication, interpersonal relationships and workflows; and 3 - Motivation to improve the work environment. No software was used to support the qualitative data processing.

All methodological paths of this study followed the standards of Resolution number 466, of December 12, 2012, of the National Health Council, and the project was approved by the Research Ethics Committee of the State Health Secretariat of the Federal District - CEP/SES /DF under Opinion No. 4,975,835, of September 15, 2021.

SciELO Data: https://doi.org/10.48331/scielodata.SOCI0F.

Results and discussion

Regarding the participants’ characteristics, all are nurses, and 88.6% are female. Age ranged from 28 to 63 years, with an average of 45 years. Regarding the time working in the sector, 4.5% have been working for less than 1 year, and 35% have been working for more than 10 years, with the average time at SES/DF being 20 years.

Based on the reports it was possible to find three cores of meaning, which were divided into three thematic categories, allowing the interpretations made in the discussion to be substantiated and interpreted in accordance with scientific production.

Environment and working conditions

The conditions of the working environment were the main difficulty highlighted by respondents and are largely linked to the scarcity of human resources, work overload, scarcity of material resources, supplies and equipment that lack maintenance. In line with such data, Pol et al.¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1414 Pol P, Zarpellon LD, Matia G. Factors of (dis)satisfaction in the work of the nursing team in pediatric ICU. Cogitare Enferm 2014; 19(1):64-71. point out that health professionals expect to find available and adequate resources, supplies and material, as well as appropriate equipment and physical structure to efficiently perform the functions inherent to each category. For Nouri et al.¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1515 Nouri A, Sanagoo A, Jouybari L, Taleghani F. Contextual Barriers of Respectful Workplace in Nursing: A Focused Ethnography. Iran J Nurs Midwifery Res 2021; 26(4):349-354. the high workload, lack of nursing resources and work stress constitute barriers to an adequate and respectful work environment.

Similar studies have found that working with a persistent lack of human resources, materials and supplies, in addition to corroborating dissatisfaction in the work environment, reduces the quality of the provided care¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1616 Ferro D, Zacharias FCM, Fabriz LA, Schonholzer TE, Valente SH, Barbosa SM, Pinto IC. Absenteísmo na equipe de enfermagem em serviços de emergência: implicações na assistência. Acta Paul Enferm 2018; 31:399-408..

As an example of the difficulties related to the amount of human resources in the entire health care network, studies carried out with tertiary care nursing professionals demonstrated that the excessive number of patients assigned per professional are risk factors for the occurrence of illness among nurses¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1717 Souza VSD, Matsuda LM, Freitas GFD, Marcon SS, Costa MAR. The hidden experience of nursing professionals sued for error. Rev Esc Enferm USP 2021; 55:e03668.. In a way, working conditions directly influence work activities, worker’s health and satisfaction. For Santos et al.¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1818 Santos TAD, Suto CSS, Santos JS, Souza EA, Góes MMDCSR, Melo CMM. Working conditions of nurses, nursing technicians, and assistants in public hospitals. Rev Min Enferm 2020; 24:e1339. in hospitals with precarious working conditions, the demand from users to have their needs met increases the intensity of the work of the Nursing team, as they need to improvise to replace resources, in addition to recreating the organization of the work itself to meet the needs, even with a limited number of workers or supplies.

The lack of a permanent team was a difficulty revealed in the investigated scenario. This difficulty corroborates the break in the maintenance of the routine team (doctors, nurses and other categories) who work daily horizontally in the continuity of care and in the creation of bonds between professionals and patients/family members. It is worth highlighting the relevance of horizontal communication as a powerful tool to promote shared decisions that favor the effectiveness of teamwork¹⁹19 Chaves LDP, Mininel VA, Silva JAMD, Alves LR, Silva MFD, Camelo SHH. Supervisão de enfermagem para a integralidade do cuidado. Rev Bra Enferm 2017; 70:1106-1111.. However, offering overtime to cover the work schedule was the alternative found to avoid closing hospital beds.

Currently, absenteeism due to illness is one of the biggest problems in the public service, and in response to this demand, the Health Secretariat of the Federal District has used overtime processes for all care sectors, aiming to cover absences and maintain the operation of the units. Estimates indicate that, in 2040, the Brazilian population of working age will consist of approximately 57% of people over 45 years of age. However, this demographic effect, associated with working conditions, favors functional aging, which is observed before chronological aging, affecting the ability to work²⁰20 Santi DB, Barbieri AR, Cheade MDFM. Absenteísmo-doença no serviço público brasileiro: uma revisão integrativa da literatura. Rev Bras Med Trab 2018; 16(1):71-81.. Therefore, considering the old employees working in the Rooming-in Service (RIS) of the assessed hospital, it is possible to understand the higher prevalence of sick leave among employees with longer service time.

Regarding the condition of the equipment, nurses reported that it is old and has no maintenance contract. They mentioned that the hospital’s own maintenance service is inefficient, there is a lack of materials and human resources to meet the institution’s demands. They suggested the return of preventive and corrective maintenance contracts with specialized companies, emphasizing that they waste time with the PDPAS (Progressive Decentralization of Health Actions Program) process, which does not solve the problem, as the equipment is not repaired¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642..

Without a doubt, working conditions directly influence work activities, worker’s health and satisfaction¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.. Long working hours are one of the main factors that lead workers to become dissatisfied and stressed, leading to illness¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,2121 Camargo SF, Almino RHSC, Diógenes MP, Oliveira Neto JPD, Silva IDSD, Medeiros LCD, Dantas KGR, Camargo JDDAS. Qualidade de vida no trabalho em diferentes áreas de atuação profissional em um hospital. Cien Saude Colet 2021; 26:1467-1476.^,2222 Pimentel NDJS, Silva RRC, Oliveira YHA, Silva AGI. A satisfação dos trabalhadores de enfermagem como indicador de gestão. Rev Eletr Acervo Saude 2020; 55:e3258.. Stress can occur when the demands of work exceed the worker’s abilities to face them, which can result in excessive physical and psychological wear and tear on the body, interfering with productivity. For Santos et al.¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1818 Santos TAD, Suto CSS, Santos JS, Souza EA, Góes MMDCSR, Melo CMM. Working conditions of nurses, nursing technicians, and assistants in public hospitals. Rev Min Enferm 2020; 24:e1339. in hospitals with precarious working conditions, the demands from users to meet their needs increases the intensity of the Nursing team’s work, as they need to improvise to replace resources, in addition to recreating the organization of the work itself to meet the needs, even with a limited number of workers or supplies.

The physical structure, the lack of medical-hospital material and damaged equipment without maintenance are identified as potential generators of occupational stress, with a direct influence on the quality of the service provided. These findings corroborate studies that verified that the physical structure, materials and equipment of good quality, combined with qualified and motivated professionals, produce health and are capable of transforming supplies into results, optimizing work and providing a better quality of life¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1616 Ferro D, Zacharias FCM, Fabriz LA, Schonholzer TE, Valente SH, Barbosa SM, Pinto IC. Absenteísmo na equipe de enfermagem em serviços de emergência: implicações na assistência. Acta Paul Enferm 2018; 31:399-408..

It is worth highlighting that the organizational climate reflects a momentary state of the organization, which can be altered by any changes in the environment or context¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,2323 Cardoso HF, Forlini JB, Dias JP. Climate and Organizational Support: Evaluation and Relationship between the Thematic Areas. CES Psicol 2019; 12(2):65-82.. However, it is worth emphasizing that in public services, such as the assessed hospital, the government has a dual role: both as a regulator and supervisor of working conditions, based on regulatory norms and other standards, and as an employer, which must provide working conditions. However, a contradiction can be observed: the same government that regulates and monitors working conditions is also the one that makes its services precarious, putting users and workers at risk, such as in public health services¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1818 Santos TAD, Suto CSS, Santos JS, Souza EA, Góes MMDCSR, Melo CMM. Working conditions of nurses, nursing technicians, and assistants in public hospitals. Rev Min Enferm 2020; 24:e1339..

Communication, interpersonal relationships and workflows

Regarding the interaction between workers, the majority of respondents considered that it could be improved. The speech about the (de)valuation of professional nurses and nursing stood out specifically in the Obstetric Center and in the Adult Emergency Room. Each hospital service presents itself as one of the important scenarios in which interpersonal relationships take place, and the hospital environment, although full of specificities (tension, chronic stressors, high demands, lack of human resources, materials and social support), has the same dynamics of many organizations²⁴24 Hirschle ALT, Gondim SMGG. Estresse e bem-estar no trabalho: uma revisão de literatura. Cien Saude Colet 2020; 25(7):2721-2736..

In the work context, it is common for teams to show low integration between their members, ineffective communication and non-collaborative behavior¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,2525 Lage CEB, Alves MS. (Des)valorização da enfermagem: implicações no cotidiano do enfermeiro. Enferm Foco 2016; 7(3/4):12-16.. To improve this process, the manager must pay attention to the professionals who constitute the team and the relationships between them, since being a “team” is strongly associated with carrying out tasks, activities shared between different people and which, together, achieve a desired result¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642..

In line with these findings, other studies²⁵25 Lage CEB, Alves MS. (Des)valorização da enfermagem: implicações no cotidiano do enfermeiro. Enferm Foco 2016; 7(3/4):12-16.^,2626 Ventura CAA, Mendes IAC, Silva ÍR, Marchi-Alves LM, Almeida EWS, Godoy SD. De autonomia roubada ao fortalecimento da profissão: conexões entre Enfermagem Brasileira e Africana. Esc Anna Nery 2021; 25(3):e20200265. report that it is clear that the lack of value attributed to the profession demotivates them, causing the professionals themselves to question their importance and value to society. The difficulties found come from the lack of recognition, professional autonomy and the difficulty of working with the multidisciplinary team, especially with doctors.

When looking at health practices, one realizes how much there is to be deconstructed and re-signified in this field, as the hegemony exercised by the biomedical power acts as a power line to manage professional acts²⁷27 Franco TB, Emerson EM. Trabalho, produção do cuidado e subjetividade em saúde: textos reunidos. São Paulo: Hucitec; 2013.. The nurse and other non-medical professionals in the multidisciplinary team are unaware of the extraordinary strength they have to deconstruct this current model and to make radical changes in the way care is produced, where the worker’s self-government over their work process places them at the position of being the main agent of change.

This devaluation reported by nurses directly reflects on professional satisfaction in their work environment. The difficulties encountered by nurses, in relation to the lack of autonomy, as a reflection of the lack of recognition of their value and importance for the health sector are characteristics present in several countries. The prejudice experienced by nursing is analyzed in the social relationships that corroborate the experience of exclusion of nurses, who often accept this condition because they are inserted in a social context in which this limited concept is crystallized²⁶26 Ventura CAA, Mendes IAC, Silva ÍR, Marchi-Alves LM, Almeida EWS, Godoy SD. De autonomia roubada ao fortalecimento da profissão: conexões entre Enfermagem Brasileira e Africana. Esc Anna Nery 2021; 25(3):e20200265.. Many conflicts experienced by the nursing staff arise from the predominance of the biomedical model, in which the professional is unable to practice their profession autonomously, being subordinate to the orders/approvals that doctors impose.

Another aspect identified in the participants’ statements was dissatisfaction with the lack of routines and workflows in the hospital. Teamwork planning constitutes one of the strategic components for coping with the growing complexity of the organization of health care services¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,2828 Silva GTRD, Varanda PAG, Santos NVCD, Silva NSBD, Salles RS, Amestoy SC, Queirós PJP. Management and leadership in the nurses' perception: A walk in the light of professional burocracy. Esc Anna Nery 2021; 26:e20210070.. These actions can make workers see themselves in the workplace, identifying weaknesses and potentials, remembering that each worker in their work environment is unique, endowed with capabilities and difficulties and motivated by different factors¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,2323 Cardoso HF, Forlini JB, Dias JP. Climate and Organizational Support: Evaluation and Relationship between the Thematic Areas. CES Psicol 2019; 12(2):65-82..

Resistance is something natural for human beings, especially when they feel threatened in their work environment. Resistance to change is one of the dimensions that influence the environments of healthcare organizations. This dimension is related to changes in work routines into a more efficient one and involves the participation of employees in this process of implementation and adaptation to a new system. The change process generally occurs through meetings between managers and employees and, as in any proposed change in the institution’s work process, it is important to involve all employees who will be affected directly or indirectly²⁹29 Tagliocolo C, Araújo GCD. Clima Organizacional: um estudo sobre as quatro Dimensões de análise [Internet]. Simpósio de Excelência em Gestão e Tecnologia (SEGeT); 2011 [acessado 2023 jun 10]. Disponível em: https://www.aedb.br/seget/arquivos/artigos07/439_SEGeT%20-%20Clima%20Organizacional.pdf.
https://www.aedb.br/seget/arquivos/artig... .

Motivation to improve the work environment

The respondents believe that the management can invest in a Human Resources replacement policy, replacement of materials and supplies and in the search for agreements on equipment maintenance contracts, aiming to offer better working conditions. In a similar study, it was found that when the physical structure is inadequate and there is a persistent lack of human and material resources, wrecked equipment, in addition to corroborating dissatisfaction in the work environment, there is a reduction in the quality of assistance provided¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1616 Ferro D, Zacharias FCM, Fabriz LA, Schonholzer TE, Valente SH, Barbosa SM, Pinto IC. Absenteísmo na equipe de enfermagem em serviços de emergência: implicações na assistência. Acta Paul Enferm 2018; 31:399-408..

The speeches point out the need to prioritize moments of collective dialogue with the team; they suggest holding sporadic meetings, recorded in minutes and made available in the Electronic Information System of the Health Secretariat of the Government of the Federal District (SEI/GDF) for the signature of participants¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.. These ordinary and sporadic meetings are crucial for strengthening teamwork, as it is on this occasion that the “dirty laundry” can be aired, when problems common to work teams and all services are raised and discussed in the light of reason and the technical knowledge of the multidisciplinary team. These moments encourage the sharing of collective experiences and establish trust among team members¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,1414 Pol P, Zarpellon LD, Matia G. Factors of (dis)satisfaction in the work of the nursing team in pediatric ICU. Cogitare Enferm 2014; 19(1):64-71..

Leadership skills constitute one of the most important skills in the organizational environment. Leadership is the process of leading actions and influencing other people’s behavior and mentality to achieve established objectives and goals. In the hospital environment or in any organization, leadership is intertwined with another dimension of the organizational climate, which is motivation, and each employee will have a perception of whether they are motivated or not²⁹29 Tagliocolo C, Araújo GCD. Clima Organizacional: um estudo sobre as quatro Dimensões de análise [Internet]. Simpósio de Excelência em Gestão e Tecnologia (SEGeT); 2011 [acessado 2023 jun 10]. Disponível em: https://www.aedb.br/seget/arquivos/artigos07/439_SEGeT%20-%20Clima%20Organizacional.pdf.
https://www.aedb.br/seget/arquivos/artig... .

In search for quality of life at work, it is necessary to make efforts to improve the quality of life in the organization, establish more satisfactory and productive positions for employees, implement different techniques to reformulate and align work functions and processes with employees. A high quality of life can be achieved through the joint effort of individuals and the organization³⁰30 Souza NS, Kich MC, Cunha AS. Clima organizacional: Prevenindo o bem-estar dos colaboradores. Rev Cien Gerenc 2017; 21(34):145-150.. For Rodrigues et al.³¹31 Rodrigues FMA, RPG, Martins MM. Cultura organizacional para a mudança num contexto hospitalar: uma perspectiva de enfermagem. Acta Paul Enferm 2023; 36:eAPE00551. although it is possible to individualize conditions that both facilitate and hinder the process of implementing changes, it is essential to consider them from a systemic and integrative perspective.

According to Borges et al.³²32 Borges E, Queirós CML, Vieira MRFSP, Teixeira AAR. Perceptions and experiences of nurses about their performance in the COVID-19 pandemic. Rev Rene 2021; 22:e60790. there is no doubt that the environment and organization of work are essential for the quality of life at work, patient safety and employee motivation. Therefore, it is important to promote, in organizations, cultures in which the involvement and empowerment of professionals are aligned with transformational leadership, a predictor of quality of care in health organizations³¹31 Rodrigues FMA, RPG, Martins MM. Cultura organizacional para a mudança num contexto hospitalar: uma perspectiva de enfermagem. Acta Paul Enferm 2023; 36:eAPE00551.. That current managers seek dialogue with care professionals and be open to suggestions from employees who rely on teamwork and aim to promote changes and improvements in the work environment is desirable¹1 Carvalho EMP, Brito CLM, Villas MBP, Muniz GC. Dificuldades e potencialidades relacionadas ao clima organizacional dos servidores de enfermagem de um hospital público. New Trends Qualitative Res 2022; 13:e642.^,3333 Dias GC, Furegato ARF. Satisfaction in, and impact of work on, the multidisciplinary team in a psychiatric hospital. Rev Enferm UERJ 2016; 24:e8164..

Final considerations

We understand that the objectives proposed for this study were achieved. It was possible to obtain a general understanding of the main challenges related to the organizational climate of employees at the assessed public hospital. The respondents’ statements disclosed the dissatisfaction related to working conditions, lack of human resources/work overload, scarcity of material resources and supplies, and equipment requiring maintenance.

We highlight that in certain sectors, such as the Obstetric Center and the Adult Emergency Room, the greatest dissatisfaction was due to the devaluation of nursing when compared to other categories; in the rooming-in service, it was revealed that sick leaves increase absenteeism rates in the unit and overloads the team; in the NICU, in addition to the difficulties common to all sectors, there was a shortage of medical-hospital material, and damaged equipment that lacked maintenance. The lack of organization of work flows and protocols was the focus of the respondents, mainly for the Surgical Center, MSC, Obstetric Center and NICU.

The challenges posed to managers go beyond the technical and structural dimension, the technological complexity of equipment without maintenance; it unfolds through the human dimension, the feelings and the unmet needs (for appreciation) of nurses and nursing, which needs to be cared for, valued, heard and seen in their care process. It goes through the feelings and unmet needs of the NICU team when they despair due to the lack of incubators and other equipment necessary for the Unit operation and, due to the illness of rooming-in professionals, which increases the organization’s absenteeism rates.

Regarding the limitations of the present study, we highlight that the data collection period occurred in the context of the COVID-19 pandemic, which may have influenced the organizational climate.

We expect that the results found can support managers in promoting strategies aimed at people management, work environment, working conditions, work safety, cooperation, communication, appreciation and recognition, to intervene with conditions considered inadequate, increasing the capacity to manage, cope with and modify the identified scenario.

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